TKR after posttraumatic and primary knee osteoarthritis: a comparative study

Abstract

Background A few literatures reported that the outcomes of total knee replacement (TKR) in posttraumatic osteoarthritis (PTOA) were lower compared to TKR in primary osteoarthritis (primary OA). The study’s purpose was to compare the comorbidity and outcome of TKR among fracture PTOA, ligamentous PTOA, and primary OA. The secondary aim was to identify the effect of postoperatively lower limb mechanical axis on an 8-year survivorship after TKR between PTOA and primary OA. Methods Seven hundred sixteen patients with primary OA, 32 patients with PTOA (knee fracture subgroup), and 104 PTOA (knee ligamentous injury subgroup) were recruited. Demography, comorbidities, Charlson Comorbidity Index (CCI), operative parameters, mechanical axis, functional outcome assessed by WOMAC, and complications were compared among the three groups. Results PTOA group was significantly younger (p<0.0001) with a higher proportion of men (p=0.001) while the primary OA group had higher comorbidities than the PTOA group, including anticoagulant usage (p=0.0002), ASA class ≥3 (p<0.0001), number of diseases ≥ 4 (p<0.0001), and CCI (p<0.0001). Both the fracture PTOA group (p<0.0001) and ligamentous PTOA group (p = 0.009) had a significantly longer operative time than the primary OA group. The fracture PTOA group had significantly lower pain components and stiffness components than the primary OA group. There was no significant difference in the rate of an aligned group, outlier group, and an 8-year survivorship in both groups. Conclusion The outcome following TKR in the fracture PTOA was poorer compared to primary knee OA in the midterm follow-up. However, no difference was detected between the ligamentous PTOA and primary knee OA. The mechanical axis alignment within the neutral axis did not affect the 8-year survivorship after TKR in both groups. Level of evidence Level III; retrospective cohort study

Preoperative Risk Factors of Persistent Pain following Total Knee Arthroplasty

“…Moreover, indications for TKA were nonuniform or unknown (rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, etc. ), while TKA in posttraumatic arthritis may be less successful than TKA in primary OA in terms of pain [ 42 ]. Hardly any information of preoperative ROM or degree of valgus/varus deformity was given, which may be confusing because severe valgus deformity is more challenging in TKA and results may be relatively worse than in varus knees [ 43 , 44 ].…”

Increased complications rates and inferior patient reported outcomes following total knee arthroplasty due to post‐traumatic osteoarthritis with previous fracture treatment: a systematic review

“…In the PTOA group, 4001 (69.8%) patients had had their previous fracture around the knee treated with osteosynthesis, 265 (4.6%) patients had been conservatively and in 1463 (25.5%) patients, the method of their fracture treatment was not specified. Postoperative complications were the most frequently reported outcome measure, reported in all studies, followed by [20,24,25,35,36,40]. The majority of included studies does not refer to the specific type of TKA implant used, however, in the studies that this information is provided, cruciate retaining or posterior stabilised implants were used, without reporting the need of using more constraint type of implants.…”

Features and Results of Knee Arthroplasty after Knee Fractures Fixation

“…после операции. Большинство авторов, указывают на то, что остеосинтез внутрисуставных переломов в анамнезе приводит к более высокой частоте послеоперационных осложнений при первичном ТЭКС [12,14,15,17,18,19,20]. При этом риск развития интра-и послеоперационных осложнений после переломов проксимального отдела большеберцовой кости существенно выше в обоих ситуацияхпри выполнении артропластики после металлоостеосинтеза или по первичным показаниям [21,22,23,24,25].…”

“…Показания к ТЭКС после переломов возникают при развитии выраженного посттравматического остеоартроза, как правило сопровождающегося деформациями суставных поверхностей, осевыми нарушениями конечности, стабильности коленного сустава и его контрактурами [11]. Анализ литературы о влиянии остеосинтеза внутрисуставных переломов на результаты ТЭКС демонстрирует противоречивые взгляды исследователей на оп-трАВмАтОЛОгИЯ И ОртОпЕДИЯ рОССИИ / TrAUmAToLogy AND orThopEDICS of rUSSIA тимальный объем предоперационного обследования, особенности оперативного вмешательства и функциональные результаты [12,13,14,15].…”